Recent advances in diagnostic testing and therapeutic management have greatly improved our ability to deliver care to patients with disorders of hemostasis. Many individuals remain inadequately evaluated or treated, however, for a variety of reasons, including incomplete or incorrect diagnostic testing, inadequate management strategies, and patient lack of access to the healthcare system. We implemented the Duke Comprehensive Hemostasis & Thrombosis Center to integrate existing areas of clinical expertise in the Duke University Health System into a coordinated service. The Center also provides access to clinical research 3rotocols, emphasizes patient education, and has provided the groundwork for developing a training program for healthcare providers interested in disorders of hemostasis. The following Aims will enhance the activity and mission of the Duke Hemostasis & Thrombosis Center. (1) Determine the efficacy of integrated multi-disciplinary care and prevention services for persons with hemophilia, other hereditary bleeding disorders including women with bleeding disorders, and thrombophilia to reduce morbidity and mortality associated with bleeding and clotting diseases. Monitoring strategies will focus on clinical outcomes, patient access, and patient satisfaction. (2) Assess unmet needs for service delivery and identify outreach strategies designed to improve access to care. Unmet needs will be identified at a local level as well as at regional and national levels. (3) Develop effective messages aimed at disease management and prevention. Internet-based as well as paper-based educational messages will be developed to promote patient awareness and education. (4) Foster the development of training programs to enhance provider skills for the delivery of care to persons with disorders of hemostasis. We will use the information obtained through these Aims to enhance the quality of the clinical services that are provided through the Duke Hemostasis & Thrombosis Center, as well as developing exceptional training opportunities for healthcare providers, clinical researchers, and basic investigators.